Health Care

NZ research shows potential for first gonorrhoea vaccine

NZ research shows potential for first gonorrhoea vaccine”

That's a big deal because worldwide each year, an estimated 78 million people contract gonorrhea, a sexually transmitted disease that can cause pelvic inflammation, infertility and throat infections.

"We are still a long way before we develop a vaccine for gonorrhoea, but we have now some evidence that it is possible".

The importance of preventing people developing a gonorrhoea infection is of mounting importance as the infection is getting much harder to treat.

A vaccine for meningitis B may stop the spread of antibiotic-resistant super-gonorrhoea.

Lead author Dr Helen Petousis-Harris, of Auckland University, said: 'This is the first time a vaccine has shown any protection against gonorrhoea. Even if these work, bacteria could evolve to evade them.

Petousis-Harris was clear about what needed to happen next.

New Zealand had a very bad meningococcal outbreak in the early 2000s caused by the B strain.

"I realised this was a natural experiment", says Steve Black of Cincinnati Children's Hospital in Ohio. In the absence of a vaccine, the government requested help from the World Health Organization to "tailor-make" one.

Meningococcal disease is rare but very unsafe. The vaccine used, known as "MeNZB", was created to protect against meningococcal group B infection - the cause of the most deadly form of meningitis.

In New Zealand, around 1 million people under age 20 received a meningitis vaccine known as MeNZB during a 2004-2006 immunisation programme. New Zealand scientists then published their results for the impact of the vaccine on the outbreak. "If the 4CMenB vaccine, which is now available in many countries, is shown to have a similar effect to the MeNZB vaccine, then administering it in adolescent immunisation programmes could result in declines in gonorrhoea", said co-author Professor Steven Black, Cincinnati Children's Hospital, USA.

Bacteria that cause meningitis and gonorrhea are actually close kin, sharing 80 to 90 percent of their DNA. "They're cousins, if you will", he said, explaining that the genetic makeup of the two is "85 to 90% similar".

Petousis-Harris and her colleagues looked later to see if gonorrhea rates had changed after that meningococcal vaccination campaign. For the primary analysis, cases were those with confirmed gonorrhea only, and controls were those with chlamydia only.

Researchers wanted to assess the vaccine's effectiveness against gonorrhea on the basis of ecological data suggesting that gonorrhea declined after the use of outer-membrane vesicle (OMV) meningococcal B vaccines in Cuba, New Zealand, and Norway.

"This is exactly what we saw", Petousis-Harris wrote in an email. Vaccinated individuals were significantly less likely to have gonorrhoea than controls. And taking into account factors such as ethnicity, deprivation, geographical area and gender, having the MeNZB vaccine reduced the incidence of gonorrhoea by around 31 percent.

MeNZB was developed to control a meningococcal disease epidemic and is no longer available, but the OMV antigens thought to provoke the immune response to gonorrhoea have been included in the more recently developed 4CMenB vaccine, available in many countries. This is a 13% increase from the previous year.

The last remaining drugs to cure this sexually transmitted infection are showing signs they may only have a few more years of usefulness left.

"For women, it can increase their risk for a life-threatening ectopic pregnancy", Bowen said.

There are fears gonorrhoea is becoming untreatable as antibiotics fail.

Gonorrhea is still treatable in the United States, said Bowen, though resistance to the current antibiotics may develop. Bexsero is made to offer broader coverage by fighting more strains than the original. "The next step for GSK is to further explore and understand the potential of Bexsero to help protect against (gonorrhea)".

Fellow researcher Prof Steven Black, from Cincinnati Children's Hospital in the U.S., said: "The potential ability of a group B meningococcal vaccine to provide even moderate protection against gonorrhoea would have substantial public health benefits". No such link was found between the vaccine and chlamydia. "This is really a universal issue", he said.

Gonorrhea, noted Black, is in all countries. "It doesn't kill, but it maims".

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